US Market Report for Anastomosis Assist Devices 2018 - MedCore
Anastomosis assist devices (AADs) are used for joining two blood vessels, usually to restore continuity after resection, or to bypass an unresectable disease process. Coronary artery bypass graft (CABG) involves the construction of an alternative path to bypass a narrowed or occluded diseased coronary artery and restore blood flow from the aorta to an area beyond the occlusion. This is accomplished by using harvested veins or arteries as bypass grafts. This harvested vessel is usually the saphenous vein in the leg, the radial artery in the arm or the mammary artery from the chest wall. One end of the harvested vessel is then generally attached to the aorta (proximal anastomosis) and the opposite end is attached to the target coronary vessel on the heart (distal anastomosis). If the mammary artery is used as the bypass graft, it is dissected from the chest wall, leaving the blood inflow end in place, while the opposite dissected end is attached to the target vessel. This provides uninterrupted blood flow and eliminates the need for proximal anastomosis to the aorta. Regardless of the type of vessel used, once in place, these grafts provide sufficient blood flow to bypass the narrowed or occluded portion of the coronary artery.
The traditional and most common method of performing anastomosis typically involves tedious and time-consuming hand-sewn placement of individual stitches with a continuous suture to connect the bypass graft proximally to the aorta and distally to the coronary vessels. Anastomosis is viewed by surgeons as the most critical step in performing CABG procedures, and using traditional methods, the process can take 10 to 25 minutes to perform the necessary suture for each point of anastomosis. Most surgeons prefer to use a continuous suture because placement of sutures individually is considered to be more challenging and time-consuming. Whether the procedure is on-pump or off-pump, hand-sewn proximal anastomosis generally requires clamping of the aorta, which carries the risk of neurological damage and other serious adverse effects. Although methods to allow hand-sewn proximal anastomosis without clamping have been developed, the time-consuming nature of manually applied sutures and the limitations associated with their use have fueled the need for fast, efficient and reliable automated systems to hasten and facilitate anastomoses done during CABG procedures. Thus, AADs have been developed for this purpose and replace the need for surgeons to manually hand suture two blood vessels to perform the anastomosis. The growing popularity of AADs has helped to significantly reduce surgical procedure times. In addition, AADs have significantly reduced the inherent difficulty in performing anastomosis in beating-heart procedures.